Healthcare Provider Details

I. General information

NPI: 1700632296
Provider Name (Legal Business Name): DONNELLA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7812 EDINGER AVE STE 400
HUNTINGTON BEACH CA
92647-3727
US

IV. Provider business mailing address

1333 S MAYFLOWER AVE STE 220
MONROVIA CA
91016-5239
US

V. Phone/Fax

Practice location:
  • Phone: 714-916-0641
  • Fax:
Mailing address:
  • Phone: 818-241-6780
  • Fax: 888-588-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: